Name and scope of NP/PA's
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With all the talk of PA's wanting a new name and both parties wanting to practice their full scope in all states, I think it should be discussed together. I realize the nuances between the two... Read More

A lot of urgent care centers here in SC have NO APRN's on staff. I think due to the supervision of PA's malpractice is next to nothing. The supervision is a little different for the two. PA's have to have an MD on site 75% of the time, but hardly have to have anything signed off by the supervisor. NP's can practice without an MD on site, but have to have their own malpractice, as well as two MD's to sign their license. Their also has to be a set protocol for what they can and cannot treat. Anything falling out of the protocol has to be referred to a MD. It is hard to get a MD to sign your license, so many work with an MD, that way malpractice is cheaper, and you always have someone to sign your license. Same treatment protocol, which makes PA's able to have a little more freedom with the actual treating of patients.

The current thought model on how PAs can become independent is through CAQ (certification of additional qualifications), which has only come out in the last few years and there isn't one for every specialty yet. They are written by specialty PAs and MDs and are intended to resemble allopathic board certifications. These exams are only allowed to be taken after a residency or so many years of full time practice.

No PA is arguing for independence in say, neurosurgery, but many are grumbling that after residency/time in practice with a passing CAQ score, they should be independent in specialties such as FP, EM, outpatient settings, ect.

As a side note, it is commonly accepted by PA leaders that residencies in specialties will become the norm. Either through legislation (similar to degree creep how NPs need a Master's degree to practice in many states now), or by self-selection as jobs will start to only take residency trained PAs with a passed CAQ. It happened to the docs the same way. First, all you had to do was graduate med school, then legislation required an intern year. Now you can work in any specialty after an intern year legally, but no hospital will hire/credential you and you could be sued into oblivion.

Will independence for PAs ever happen? Who knows. More than likely the best they can hope for in this lifetime is collaborative practice and untie themselves from "supervision," and with no physician liability they will be able to demonstrate they can stand on their own two feet. It is hard to show that you are competent if the physicians are taking credit for you work through "supervision." No way to prove if it was a PA or the MD that did the heavy lifting. If any of it does, it will be much more slowly than NPs progress and it will likely be without the help of the AAPA. The House of Delegates for the AAPA won't even consider studying the cost/effect of a name change. Though a new organization, PAs for Tomorrow, has started just in the past month and is attempting to reach critical mass so that they may take on the issues the AAPA won't touch.